© Copyright 2005 dbMotion Ltd. By dbMotion RIM Based Semantic Interoperability Assaf Halevy, Co – Founder & VP Strategic Accounts [email protected].

© Copyright 2005 dbMotion Ltd.

By dbMotion

RIM Based Semantic Interoperability

Assaf Halevy, Co – Founder & VP Strategic Accounts

[email protected]


© Copyright 2005 dbMotion Ltd. 3

Agenda

• The challenge of Interoperability

• Interoperable Data Model

• The Semantic Context and Vocabularies

• Business Services in use

• Demo


Community Record Architecture

4Data Displayed, Pulled or Published Back

Organize

Virtual Patient

Utilize

Applications & Tools

Interoperable Patient Viewer

Physician Results/Events App

Population Manager

Software Dev KitPHR Connector

AnalyticsResearch

NHIN/RHIOIHE

Data UseTools

Examples

Other Sources

Publish

EMR Sources


HINMulti-Hospital Organization

Primary Care & Specialized Clinics

Commercial Lab

Pharmacies

Tertiary Medical Center


Architecture

6

Security

Layer

Shared Services

System Management

Layer

OperationalEnvironment

Presentation Layer

Business Layer

Communication Layer – Message Bus

Data Layer

Data Integration Layer


• Longitudinal Patient Record

• Semantically Harmonized

• Discretely Consumable

• Standards Based Integration- CDA/CCD/CCR/XML

- IHE

- SOA

7

Architecture: Virtual Patient Object

VPO as XML.xmlVPO as CCD.xml


Unified Medical Schema


UMS Vision

“Define a data model that supports semantic clinical information sharing, while maintaining its meaning, standardization and context. The data model should provide any consumer with actionable, reusable data in a timely manner.”


HL7 v3.0: What and Why

• Version 3.0 is a model-driven methodology described in UML diagrams

• The HL7 v3.0 development methodology includes - Use of a Reference Information Model (RIM)

- Robust datatypes and vocabulary specifications

- Modeling of the dynamic requirements of messages.

• HL7 v3.0 increases the quality and reduces the variability in HL7 standards enabling it to address the more complex and diverse needs of the HL7 members.

• v3.0 enables HL7 implementers to leverage emerging web services standards, conventions, and technologies


Patient Medical Schema

Encounter

SourceRetrieveCreateValidCodeClassNameInstitutePhysicianDischargePurposeReport

Observation Conclusion Operation

Patient

Identifier

Laboratory

SourceRetrieveCreateValidCodeClassNameReport

Imaging


Medication

SourceRetrieveCreateValidCodeNameFormPrescribedPrescriberDispensedPeriodDosageFrequencyRouteInstructionReasonReport

Procedure


Measurement


Device


Diagnosis


Allergy

SourceRetrieveCreateValidCodeClassNameSeverityReport

Sensitive


Demography

SourceRetrieveCreateValidCodeClassIdGenderBirthDeathFamilyGivenStatusDriverCountyStateCityAddressPostalPhoneMobile

Dispense

CodeNameForm

Ingredient

NameClassStrength

Message

SourceValidCodeClass


UMS Methodology

HL7 RIMHL7 RIM

D-MIMD-MIMPreviousPrevious UMS UMS

CDMCDM

LDMLDM

«PatientEncounter»Encounter

- classCode : d_ActClass = ENC- moodCode : d_ActMood = EVN

+ id_Root : string(50)+ id_Extension : string(50)

+ code : d_ActEncounterCode = AMB, EMER, <=IMP, HH+ statusCode : d_ActStatus = active or completed+ effectiveTime_start : Date(wtz)+ effectiveTime_end : Date(wtz)+ priorityCode : d_ActPriority = R, UR+ lengthOfStayQuantity_value : Double(.2)+ lengthOfStayQuantity_unit : d_UnitsOfMeasureCaseInsensitive+ dischargeDispositionCode : d_EncounterDischargeDisposition+ admissionReferralSourceCode : d_EncounterAdmissionSource+ «dbm» dbmAvailabilityTime : Date(ntz)

«ActRelationship»EncounterDiagnosis

+ typeCode : d_ActRelationshipType = RSON,PERT+ priorityNumber : Integer

1*

- source

component of

*

0..1

- target

- source

«Patient,Person[player],Role,Place[player]»PatientRecord

- Ent_classCode : d_EntityClass = PSN- determinerCode : d_EntityDeterminer = INSTANCE- statusCode : d_EntityStatus = active+ administrativeGenderCode : d_AdministrativeGender = F, M, UN+ birthTime : Date(ntz)+ deceasedInd : Boolean+ deceasedTime : Date(wtz)+ maritalStatusCode : d_MaritalStatus = D, L, M, S, W+ ethnicGroupCode : d_Ethnicity+ religiousAffiliationCode : d_ReligiousAffiliation+ raceCode : d_Race+ «Role[PAT]» veryImportantPersonCode : d_PatientImportance+ «role[BIRTHPL],Place[COUNTRY]» birthCountryCode : d_CountryEntityType

«Organization»Organization

- classCode : d_EntityClass = ORG- determinerCode : d_EntityDeterminer = INSTANCE

+ id_root : string(50)+ id_extension : string(50)

+ code : d_OrganizationEntityType+ name : string(50)+ statusCode : d_EntityStatus = active+ «Role[PART].code» orgPartCode : d_OrganizationPartRoleType

«ManagedParticipation»AttenderPracticioner

+ typeCode : d_ParticipationType = ATND, ADM, CON, DIS+ time_start : Date(wtz)

+ time_end : Date(wtz)+ statusCode : d_ManagedParticipationStatus = active, completed

1

* assigned organization (or institute)

- player

0..*

1

Subject

1

*

- _PatientRecord

«Role,Participation[BEN],Act»CoveredParty

- classCode : d_RoleClass = COVPTY+ statusCode : d_RoleStatus = active, completed+ «act[COV]» code : d_ActInsurancePolicyCode

+ «participation[COV]» sequenceNumber : Integer+ effectiveTime_start : Date(wtz)+ effectiveTime_high : Date(wtz)

*

0..1

- _Encounter

1

*

Insurer organization

- scoper«Observation»Diagnoses

«HL7 Person»MedicalStaff

*1 AssignedPracticioner

- player

referrer

*

1- player

Participation[REF]Role[ASSIGNED]

*

0..1

- player

Primary provider

organization

*

0..1- Player

«HL7 Person»MedicalStaff

- classCode : d_EntityClass = PSN+ name : string(50)+ telecom : string(50)

Primary care physician

0..1

*

- Player

OrganizationPartOf

*1

«Role,Participation,Act»PrimaryCareProvider

- classCode : d_RoleClass = CAREGIVER+ code : d_HealthcareProviderRoleType+ statusCode : d_ActStatus = active, completed+ effectiveTime_start : Date(wtz)+ effectiveTime_end : Date(wtz)+ «Act[PCPR],Participation[RESP]» medicalServiceCode : d_ActMedicalServiceCode

1

*

scoper

Role[PAT]Participation[SBJ]

«Act»Imaging Request

* 0..1componentOf - target- source

- _target

1 *

«ManagedParticipation,Role»ServiceProviderUnit

- typeCode : d_ParticipationType = LOC+ time_start : Date(wtz)

+ time_end : Date(wtz)+ statusCode : d_ManagedParticipationStatus = active, completed+ «Role[SDLOC]» code : d_ServiceDeliveryLocationRoleType1 1..*

ServiceProviderUnit*

1 - scoper

«Act»LaboratoryRequest

encounter0..1* - target

«HL7 Procedure»Procedure

The Procedure's Encounter 0..1

«ClinicalDocument»ClinicalDocument

The Document's Encounter0..1

«SubstanceAdministr...Medication Request

encounter

0..1*

- source

- target

«CD»EncConfidentiality

+ confidentialityCode : d_Confidentiality = <> B

*

confidentialityCode

«CD»OrgConfidentiality

+ «Role[PART].confidentialityCode» confidentialityCode : d_Confidentiality = <> ConfidentialityModifiers and <> B

*

confidentialityCode

Participation[RESP]Role[ASSIGNED]

0..1

- player

referrer

Role[ASSIGNED]

Participation[REF]Role[ASSIGNED]

ActRelationship[COMP]

Participation[SBJ]

«II»PatientIdentifier

+ root : string(50)+ extension : string(50)

+ identifierType : d_IdentifierType+ assigningAuthorityName : string(50)+ displayable : boolean

1..*

id

1

«ENXP»PatientNamePart

+ partType : d_EntityNamePartType = FAM, GIV, SFX+ value : string(50)+ qualifier : d_EntityNamePartQualifier = AC, PR, BR, SP, CL

«EN»PatientName

+ nameUse : d_PersonNameUse

*

name

1

1..*

NamePart

1

«TEL»PateintTelecom

+ value : string(50)+ scheme : d_URLScheme = mailto, tel+ use : d_TelecommunicationAddressUse = H, WP, MC

*

telecom

1

«ADXP»AddressPart

+ partType : d_AddressPartType = STA,CNT,CTY, STR, BNR,ZIP+ value : string(50)

«AD»Postal Address

+ use : d_PostalAddressUse = H, WP

*

addr

1

1..*address part

1

«CD»PatConfidentiality

+ «Role[PAT].confidentialityCode» confidentialityCode : d_Confidentiality = <> B

*

confidentialityCode

1

participation[COV]

«CD»PCPConfidentiality

+ confidentialityCode : d_Confidentiality = <> ConfidentialityModifiers and <> B

*confidentialityCode

«dbm»PatientIdentity

+ PatientIdentity : INTEGER

*

«II»MedicalStaffIdentifier

+ root : string(50)+ extension : string(50)

+ identifierType : d_IdentifierType+ assigningAuthorityName : string(50)+ displayable : boolean

*id

leading record0..1 1

Logical Data ModelContains subject areas, classes, atomic attributes, data types and associations. Tangible representation of dbMotion semantics


UMS Domains - Summary

• Encounters

• Labs

• Diagnosis

• Imaging

• Substance

•Administration

• Procedures

• Allergies

• Clinical

Documents

• …


Medications from a Machine Perspective

Medication Date Source system

Coumadin 2 mg oral tablet 07/15/2008 10:00 CernerH1

Bactrim DS oral tablet 01/11/2008 08:30 CernerH2

PRAVACHOL 80 MG TAB 09/06/2007 13:30 EPIC

WARFARIN 1 MG TAB 04/27/2008 15:00 EPIC

Pravastatin 80 mg oral tablet 07/15/2008 10:00 CernerH1

LIPITOR 20 MG TAB 04/27/2008 15:00 EPIC


Diagnoses

LocalLocal

Medications

Allergies

Labs

Adminst.

dbMotion Ontology (Baseline)dbMotion Ontology (Baseline)

RxNorm (Subset)RxNorm (Subset)

NDF-RTNDF-RTNDF-RTNDF-RTCondition SNOMED

(Subset)SNOMED

(Subset)

Substance

Allergen

FindingLOINCLOINCLOINCLOINC


Diabetes Clinical View

16


dbMotion SOA Services

dbMotion Business Layer (SOA Based Clinical Business Domains)

dbMotion Business Domains(Patient Admin, Labs, Meds, Proc, Diag, Problems…) Business Methods Event Broker Business Processes Business Activities

KFW + KNEO

GetLabs

GetLabs

GetMeds

GetMeds

GetEncounters

GetEncounters

GetAnemia_Level

GetAnemia_Level

Is_HypertensiveIs_Hypertensive

GetLiver Enzyme State

GetLiver Enzyme State


WirelessApplications

Other Uses & Apps

Virtual Patient available to multiple applications & uses

Agility with IT: Using the Interoperable Patient Record

NHIN

Hospitals - ClinicsRegistries

IBM-CognosAnalytics

Untethered PHR


Thank you…

Assaf Halevy

[email protected]

© Copyright 2005 dbMotion Ltd. By dbMotion RIM Based Semantic Interoperability Assaf Halevy, Co – Founder & VP Strategic Accounts [email protected].

Documents

dbmotion rim

loinc slide

technologies slide

patient medical schema

virtual patient object

use demo slide

unified medical schema

epic drug allergy slide